Key result
CTO recanalization improves 12-month quality of life by ~21 points vs conservative therapy.
Why the study?
The impact of patient-related factors, including clinical and angiographic data, and procedure-related factors on quality of life in chronic coronary total occlusion remains debated.
Does an invasive strategy improve quality of life in patients with chronic coronary total occlusion compared to a conservative strategy?
RCT (n=140)
Open-label
Sealed envelopes
No
Does an invasive strategy improve quality of life in patients with chronic coronary total occlusion compared to a conservative strategy?
Absolute Event Rate: 87.4% vs 66.7%
p-value: p=0.0001
In patients with chronic coronary total occlusion, technical success of recanalization, absence of diabetes, non-LAD CTO, and higher baseline SAQ-7 score independently predict quality of life improvements, regardless of the specific recanalization technique used.
Highlights . The impact of clinical, angiographic and procedure-related factors on the quality of life of patients with chronic coronary total occlusions has been reported. Background . The impact of patient-related factors including clinical and angiographic data and procedure-related factors on the quality of life remains debating. Aim . To assess the impact of baseline and procedure-related factors on the quality of life in patients with chronic coronary total occlusion. Methods . 140 patients with chronic single-vessel disease randomly assigned either to the invasive-strategy group or the conservative-strategy group. Quality of life was measured in all patients using the Seattle Angina Questionnaire, European Quality of Life Survey, and Rose Dyspnea Scale after 3 and 12 months. To determine the predictors to the quality of life improvements in both groups, simple and multivariate regression analysis were performed. The baseline clinical, angiographic and procedure-related factors were included in the analysis. Results . The technical success of the procedure was the independent predictor to quality of life improvement in the invasive-strategy group (OR: 5.8, 95%, CI: 3,26-9.18, p = 0.001). The absence of diabetes mellitus (OR: 0.19, 95%, CI: 0.09-0.84, p = 0.04), CTO of other than left anterior descending artery (OR: 2.1, 95%, CI: 1.09-4.0, p = 0.03) and higher SAQ - 7 score at baseline (OR: 1.1, 95%, CI: 1.04-1.21, p = 0.02) independently predicted the improvements in the quality of life. The indicators of quality of life between the subgroups of subintimal and intraluminal recanalization did not differ significantly in the long-term period. The total SAQ-7 score in the subintimal recanalization subgroup was 85.5 ± 9.1 versus 89.3 ± 9.6 in the intraluminal recanalization subgroup (p = 0.21). Conclusion . The decision on the management of patients with chronic coronary total occlusions should be made individually, taking into account baseline clinical and instrumental data. The recanalization technique does not affect the quality of life. Its choice should be made individually in order to achieve technical success.
No takes yet. Share an insight, caveat, or question.
Badoyan et al. (2021) conducted an RCT in Chronic coronary total occlusion (n=140). Invasive strategy (endovascular recanalization) vs. Conservative strategy (optimal medical therapy) was evaluated on Total Seattle Angina Questionnaire (SAQ-7) score at 12 months (p=0.0001). An invasive strategy for chronic coronary total occlusion yielded significantly higher SAQ-7 total scores at 12 months than a conservative strategy (87.4 vs 66.7), with procedural technical success being a strong independent predictor of quality of life improvement (OR 5.8).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: